Background: Because health professionals can end up being first responders to a mass casualty incident, they must train to improve preparedness and increase the preconditions of victim outcomes. Training and learning on how to handle a mass casualty incident is traditionally based on reading, lectures, training through computer-based scenarios, or sometimes through live simulations. Professionals should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. Virtual reality is a promising tool for realistic and repeatable simulation training, but it needs further evaluation. This study aimed to describe the acceptability and applicability of using VR for training in mass casualty incidents.

Methods: A mixed-methods evaluation design was used, where the qualitative and quantitative findings were embedded into the discussion with a realist inquiry approach. A virtual reality simulation with mass casualty incident scenarios, named GoSaveThem ( www.crash.nu ), was used, and the participants were directed to perform triage. After the simulation, the participants filled in a questionnaire with open-ended questions and ratings on technical aspects, learning experiences, and improvement of preparedness. Eleven of the participants underwent interviews. The qualitative data was analyzed either summarily or with a conventional content analysis. Data were extracted from computer recordings of how long it took for each participant to triage the first 10 victims and to what extent the triage for the first 10 victims was correct. Descriptive statistical analyses were done, and a comparison was made to see if there were any differences between age, sex, educational background, and previous experiences that affected the outcome of triaging.

Results: Training with virtual reality enables repeatable and realistic simulation training of mass casualty incidents. The participants expressed motivation to repeat the training and experience expanded virtual reality scenarios. This study shows that the acceptability and applicability of using VR for training MCIs were high overall in all examined dimensions for most users, with some exceptions.

This study aimed to explore how students reflect on their caring encounter with a patient. For this purpose, the research has a reflective lifeworld and, as such phenomenological approach, utilizing individual written narratives as data. Before data collection, the students were educated in an approach to caring communication, supported by a life-world perspective. The students were offered a supplementary training session on the communication approach. Emphasis is placed on adopting an attitude that regards the patient as a subject with unique lived experiences. The participants were recruited from the Primary Health Care Specialist program. During the students’ clinical training, they encountered a patient and reflected upon the encounter afterwards. A reflective lifeworld research perspective was used to analyze the students’ narratives. It was found that students engaging in life-world-led encounters with patients presented various challenges, primarily in maintaining an open and flexible approach by bridling their own preunderstandings, attentively listening to patients’ narratives without interruption were highlighted as significant challenges. Remaining fully present in the moment to actively engage with patients’ descriptions was regarded by the students as both demanding and rewarding. The findings suggest the need for teachers to actually engage in reflective teaching in their professional contexts.

BACKGROUND: Intrusive memories of psychologically traumatic events bring distress both sub-clinically and clinically. This parallel-group, two-arm randomised controlled trial evaluated the effect of a brief behavioural intervention on reducing intrusive memories in frontline healthcare workers exposed to traumatic events during the COVID-19 pandemic.

METHODS: Participants with at least two intrusive memories of work-related trauma in the week before recruitment were randomised 1:1 to an imagery-competing task intervention (n = 73) or attention-based control task (n = 71). The number of intrusive memories was assessed at baseline and 5 weeks after the guided session (primary endpoint).

RESULTS: The intervention significantly reduced intrusive memory frequency compared with control [intervention Mdn = 1.0 (IQR = 0-3), control Mdn = 5.0 (IQR = 1-17); p < 0.0001, IRR = 0.30; 95% CI = 0.17-0.53] and led to fewer post-traumatic stress-related symptoms at 1, 3 and 6 month follow-ups (secondary endpoints). Participants and statisticians were blinded to allocation. Adverse events data were acquired throughout the trial, demonstrating safety. There was high adherence and low attrition.

CONCLUSIONS: This brief, single-symptom, repeatable digital intervention for subclinical-to-clinical samples after trauma allows scalability, taking a preventing-to-treating approach after trauma.

TRIAL REGISTRATION: 2020-07-06, ClinicalTrials.gov identifier: NCT04460014.

BACKGROUND: Assessment of undergraduate students using assessment instruments in the clinical setting is known to be complex. The aim of this study was therefore to examine whether two different assessment instruments, containing learning objectives (LO`s) with similar content, results in similar assessments by the clinical supervisors and to explore clinical supervisors' experiences of assessment regarding the two different assessment instruments.

METHOD: A mixed-methods approach was used. Four simulated care encounter scenarios were evaluated by 50 supervisors using two different assessment instruments. 28 follow-up interviews were conducted. Descriptive statistics and logistic binary regression were used for quantitative data analysis, along with qualitative thematic analysis of interview data.

RESULT: While significant differences were observed within the assessment instruments, the differences were consistent between the two instruments, indicating that the quality of the assessment instruments were considered equivalent. Supervisors noted that the relationship between the students and supervisors could introduce subjectivity in the assessments and that working in groups of supervisors could be advantageous. In terms of formative assessments, the Likert scale was considered a useful tool for evaluating learning objectives. However, supervisors had different views on grading scales and the need for clear definitions. The supervisors concluded that a complicated assessment instrument led to limited very-day usage and did not facilitate formative feedback. Furthermore, supervisors discussed how their experiences influenced the use of the assessment instruments, which resulted in different descriptions of the experience. These differences led to a discussion of the need of supervisor teams to enhance the validity of assessments.

CONCLUSION: The findings showed that there were no significant differences in pass/fail gradings using the two different assessment instruments. The quantitative data suggests that supervisors struggled with subjectivity, phrasing, and definitions of the LO´s and the scales used in both instruments. This resulted in arbitrary assessments that were time-consuming and resulted in limited usage in the day-to-day assessment. To mitigate the subjectivity, supervisors suggested working in teams and conducting multiple assessments over time to increase assessment validity.

UNLABELLED: Early identification of stroke symptoms is essential. The rate of stroke identification by call-takers at emergency medical communication centres (EMCCs) varies, and patients who are found in a lying down position are often not identified as having an ongoing stroke.

OBJECTIVES: this study aimed to explore signs and symptoms of stroke in patients who had fallen or were found in a lying position.

DESIGN: a retrospective exploratory qualitative study design was used.

METHOD: a total of 29 emergency calls to EMCCs regarding patients discharged with a stroke diagnosis from a large teaching hospital in Stockholm, Sweden, in January-June 2011, were analysed using qualitative content analysis.

RESULTS: during the emergency calls, the callers described a sudden change in the patient's health status including signs such as the patient's loss of bodily control, the patient's perception of a change in sensory perception, and the callers' inability to communicate with the patient.

CONCLUSIONS: The callers' descriptions of stroke in a person found in a lying position are not always as described in assessment protocols describing the onset of a stroke. Instead, the symptom descriptions are much vaguer. Therefore, to increase identification of stroke during emergency calls, there is a need for an increased understanding of how callers describe stroke symptoms and communicate with the call-takers.

BACKGROUND: How ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don't have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians' clinical reasoning when simulating a mass casualty incident using virtual reality.

METHODS: This study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs.

RESULTS/CONCLUSION: All phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.

OBJECTIVE: To explore students' and facilitators' experiences of using a developed digital activity for interprofessional learning (IPL) focusing on critically ill patient handovers from a primary healthcare (PHC) centre to the ambulance service.

DESIGN: A qualitative study design was employed, and the reporting of this study adheres to the Consolidated criteria for Reporting Qualitative research guidelines for qualitative studies.

SETTING: A PHC centre and the ambulance service in Stockholm, Sweden.

PARTICIPANTS: A total of 31 participants were included in the study: 22 students from five different healthcare professions, seven facilitators and two observers.

INTERVENTION: A digital IPL activity was developed to overcome geographical distances, and the scenario included the handover of a critically ill patient from personnel within the PHC centre to the ambulance service personnel for transport to an emergency department. Four digital IPL activities were conducted in 2021.

RESULTS: The digital IPL activity eliminated the issue of geographical distance for students and facilitators, and it enabled the students to find an interprofessional model for collaboration through reasoning, by communicating and sharing knowledge with the support of a common structure. Participants perceived the digital IPL activity and scenario as authentic, feasible and facilitated IPL. Using a case with an acute and life-threatening condition was a success factor for students to experience high realism in their IPL on patient safety, handover, care and treatment.

CONCLUSION: The developed digital IPL activity facilitated the students' IPL and demonstrated potential sustainability as the digital approach supported overcoming geographical distances for both students and facilitators. By using a scenario involving an authentic case focusing on handovers of a critically ill patient, IPL, feasibility and acceptability were supported. However, it is crucial to emphasise that a comprehensive evaluation, both quantitative and qualitative, over an extended period of clinical rotations and involving a larger group of students is still warranted to ensure continuous improvement and development.

BACKGROUND: There is a need to address the implementation of technological innovation into emergency medical services to facilitate and improve information exchange between prehospital emergency care providers, command centers, and hospitals during major incidents to enable better allocation of resources and minimize loss of life. At present, there is a lack of technology supporting real-time information sharing in managing major incidents to optimize the use of resources available.

OBJECTIVE: The aim of this protocol is to develop, design, and evaluate information technology innovations for use in medical response to major incidents.

METHODS: This study has a qualitative action research design. This research approach is suitable for developing and changing practice in health care settings since it is cyclical in nature and involves development, evaluation, redevelopment, and replanning. The qualitative data collection will include workshops, structured meetings, semistructured interviews, questionnaires, observations, and focus group interviews. This study assesses the use of a digital solution for real-time information sharing by involving 3 groups of indented users: prehospital emergency care personnel, hospital personnel, and designated duty officers with experience and specific knowledge in managing major incidents. This study will explore end users' experiences and needs, and a digital solution for prehospital and hospital settings will be developed in collaboration with technology producers.

RESULTS: The trial implementation and evaluation phase for this study is from April 2024 to May 2026. Interviews and questionnaires with end users were conducted during the planning phase. We have performed observations in connection with 2 major exercises in April 2024 and November 2024. The outcome of this analysis will form the basis for the design and development of a new information technology system. We aim to complete the observations in training sessions and exercises (phase 3) by September 2025, followed by modification of the technology solutions tested (phase 4) before dissemination in a scientific journal.

CONCLUSIONS: This protocol includes several methods for data collection that will form the basis for the design and development process of a digital solution for real-time information sharing to support efficient management in major incidents based on the experiences and requirements of end users. The findings from this study will contribute to the limited research on users' perspectives and the development of digital solutions for real-time information during major incidents.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/57819.

INTRODUCTION: First responders' training and learning regarding how to handle a mass-casualty incident (MCI) is traditionally based on reading and/or training through computer-based scenarios, or sometimes through live simulations with actors. First responders should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. High-fidelity virtual reality (VR) is a promising tool to use for realistic and repeatable simulation training, but it needs to be further evaluated. The aim of this literature review was to provide a comprehensive description of the use of high-fidelity VR for MCI training by first responders.

METHODS: A systematic integrative literature review was used according to Whittemore and Knafl's descriptions. Databases investigated were PubMed, CINAHL Complete, Academic Search Ultimate, Web of Science, and ERIC to find papers addressing the targeted outcome. The electronic search strategy identified 797 potential studies. Seventeen studies were deemed eligible for final inclusion.

RESULTS: Training with VR enables repetition in a way not possible with live simulation, and the realism is similar, yet not as stressful. Virtual reality offers a cost-effective and safe learning environment. The usability of VR depends on the level of immersion, the technology being error-free, and the ease of use.

CONCLUSIONS: This integrative review shows that high-fidelity VR training should not rule out live simulation, but rather serve as a complement. First responders became more confident and prepared for real-life MCIs after training with high-fidelity VR, but efforts should be made to solve the technical issues found in this review to further improve the usability.